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nursing > The Pediatric Patient > Flashcards

The Pediatric Patient Flashcards

1
Q

Children Metabolism

A

their metabolism altered, but it is dynamic, constantly changing as they grow

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2
Q

Stability - Children

A

incredible ability to compensate. Unfortunately, they remain stable for a time period then decompensate very rapidly. Nurses need to be vigilant in the assessment of a child to catch subtle cues to illness and instability.

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3
Q

Vital signs of children

A

Infants and children have different parameters of normal vital signs. the nurse must be knowledgeable of the age variances

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4
Q

Airway of children

A

airway of a child is much smaller than that of an adult

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5
Q

Fluid balance in children

A

Infants and children have a larger body/water content than an adult. This can result in dehydration and fluid/electrolyte imbalances much quicker

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6
Q

Medication administration for children

A

Medication dosages are weight-based in pediatrics. The nurse may also need to develop interesting approaches to medication administration to aid the infant/child in compliance with taking the medication

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7
Q

Decompensated shock in children

A

Hypotension is a late sign of shock in the infant and child. The nurse must be vigilant in assessing for early, subtle signs

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8
Q

Lab values in children

A

Lab value normal ranges are altered for the infant and child. The pediatric nurse must be familiar with acceptable ranges when caring for the infant or child

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9
Q

Maturity in children

A

Maturity - Infants and children are immature physically, physiologically, and emotionally. This can impact the medical care greatly.

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10
Q

sniffing position

A

rare occurrence for an infant or child to have cardiac failure. More often, an infant or child will experience respiratory failure that, if uncorrected, will lead to cardiac compromise.

An infant and toddler has a large occiput. Because of this, a towel is placed under the infant’s shoulders, while supine, in order to open the infant’s airway.

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11
Q

endotracheal tube (placement )

A

1-2 cm above the carina

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12
Q

endotracheal tube placement

A
  • bilateral breath sounds
  • bilateral chest expansion
  • CO2 detector

ETT may be secured with tape or a commercial ETT holder. Your text demonstrates a photo of the correct procedure of securing the ETT with tape in Figure 39.4. It is very easy for the ETT to become dislodged in the infant or child due to the size of their airway.

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13
Q

confirm endotracheal tube placement

A

Chest x-ray

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14
Q

color-coded resuscitation tape (Broselow tape)

A

Everything in pediatrics is weight based. However, it is not always appropriate to weigh a child before life-saving measures are completed. This tape is a guideline of what size tubes and dosages of medications to give a child based on the child’s length. This is used in an emergency situation.

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15
Q

The most common cause of viral bronchiolitis in infants

A

respiratory syncytial virus, or RSV

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16
Q

RSV ( respiratory syncytial virus)

A
  • highly contagious
  • uses infections of the lungs and respiratory tract. It’s so common that most children have been infected with the virus by age 2.
  • can cause severe infection in some people, including babies 12 months and younger (infants), infant with congenital heart disease, especially premature infants, older adults, people with heart and lung disease, or anyone with a weak immune system (immunocompromised)
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17
Q

RSV symptoms

A
  • severe cold-like episodes with copious amounts of drainage
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18
Q

RSV Severe symptoms

A
  • Fever
  • Severe cough
  • Wheezing
  • Rapid breathing or difficulty breathing
  • Bluish color of the skin (cynanosis)
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19
Q

Prevention for premature infants and those that are vulnerable to RSV

A

immunization, palivizumab (Synagis), is offered. This is a once a month injection during the RSV season, typically fall and winter

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20
Q

treatment of RSV

A

treatment is supportive, maintaining oxygenation. Supplemental oxygen is the primary therapy and suctioning will be needed to maintain an open airway

21
Q

asthma is chronic, and triggers are

A

bronchoconstriction
inflammation
mucous

22
Q

acute exacerbation, also known as an asthma attack treatment

A

Supplemental oxygen
Nebulized beta-adrenergic therapy
IV corticosteroids
Anticholinergic medications

23
Q

What is used to decrease the work of breathing in asthma attack

A

Heliox, which is a mixture of helium and oxygen (lighter than air

24
Q

Normal heart rate based on age

A 
New born -                       120-160
Infant (1-12 months)-         80 - 140
Toddler (1-3 yrs.)-	           80 - 130
Preschooler (3-5 yrs.)-       80 - 120	
School Age (6-12 yrs.)-      70 - 110
Adolescent (13+ yrs.)-	    55 - 105
25
Q

Normal Respiratory rate

A 
Newborn	                  30 - 50
Infant (1-12 months)	  20 - 30
Toddler (1-3 yrs.)	           20 - 30
Preschooler (3-5 yrs.)	   20 - 30
School Age (6-12 yrs.)	   20 - 30
Adolescent (13+ yrs.)	    12 - 20
26
Q

Normal systolic blood pressure

A 
Newborn			                50 - 70
Infant (1-12 months)		        70 - 100
Toddler (1-3 yrs.)			        80 - 110
Preschooler (3-5 yrs.)			80 - 110
School Age (6-12 yrs.)			80 - 120
Adolescent (13+ yrs.)			110 - 120
27
Q

Pediatric vital signs things to remember

A

REMEMBER:
The patient’s normal range should always be taken into consideration.
Heart rate, BP & respiratory rate are expected to increase during times of fever or stress.
Respiratory rate on infants should be counted for a full 60 seconds.
In a clinically decompensating child, the blood pressure will be the last to change. Just because your pediatric patient’s BP is normal, don’t assume that your patient is “stable”.
Bradycardia in children is an ominous sign, usually a result of hypoxia. Act quickly, as this child is extremely critical.

28
Q

temperature in children

A

same rules apply for children just like adults - 98.6 is normal

29
Q

Congenital heart defects

A

Congenital heart defects (CHD) occur during embryologic development of the heart. Acquired heart defects occur after birth as a result of another disorder.

There are multiple congenital heart defects. Some are cyanotic and some are acyanotic. The most common is ventricular septal defect (VSD)

30
Q

Treatment of CHF in children

A

includes inotropic agents, such as dopamine, dobutamine, and diuretics

Digoxin may be administered once stable. Watch levels (0.8-2) and s/s of digoxin toxicity

31
Q

early signs of CHF in children

A

he earliest sign of CHF is tachycardia.

Other early signs include dyspnea and fatigue.

32
Q

why is it important to recognize impeding respiratory failure in pediatrics

A

respiratory failure almost always precedes heart failure in pediatrics

33
Q

most common symptomatic tachyarrhythmia in children

A

supraventricular tachycardia (SVT), P-waves may or may not be seen. The heart rate may exceed 220 bpm. If the child is symptomatic, immediate treatment is indicated

34
Q

Treatment of SVT (supraventricular tachycardia) in children

A
  • adenosine (0.1 mg/kg) IV (remember how adenosine is given and what to expect)
  • synchronized cardioversion if IV not available
35
Q

bradycardia in children

A

Bradycardia is <100 bpm in an infant or <60 bpm in a child.

36
Q

treatment for bradycardia in children

A

Since cardiac failure is typically a result of respiratory failure in infants and children, the first treatment includes oxygenation and ventilation (this usually corrects the problem if caught early enough)
If the problem is not corrected by adequate ventilation, CPR is started for a heart rate less than 60 bpm and pediatric advanced life support is initiated

37
Q

causes of epiglottitis

A
  • infectious droplets
  • haemophilus influenzae type B
    other causes is streptococcus pneumonia
38
Q

is there a vaccine for haemophilus influenzae type B ?

A

yes, the HIB vaccine and it taken in three to four doses :

it will be given in months 2,4,6, and between 12-15.

39
Q

Signs and symptoms of Epiglottis “ ADD Air Nurse”

A

Abnormal position (tripod), Dysphagia (leads to drooling), Difficulty speaking (muffled/soft), Apprehension(anxious/feel something bad might happen), Increased temperature (high), Rapid onset, Nasal flaring, using accessory muscle to breath, retraction (chest), Stridor (inspiratory), Enlarged epiglottis (enlarged on x-ray or visible ), absent cough (sore throat can be found too )

40
Q

NSG interventions for child with epiglottitis

A

-Never insert anything in patient mouth to assess ( no tongue blade) due spasms occurring
-intubation equipment and trained staff, crash cart , never leave patient alone
-Assess oxygen status : color, o2 sat, breath sound, HR ?, retractions, nasal flaring, agitated
- keep child calm: keep w/parents, don’t restrain child , calm environment, avoid increase crying, comfortable position (tripod) and never supine position
- NPO
-Meds :
IVF, antibiotics, antipyretics, corticoid steroids’ (decrease swelling)

41
Q

Prevention of Epiglottis

A

child needs to get the vaccine

42
Q

Anytime patient has head injury….?

A

stabilize cervical spine

43
Q

ICP ealry signs in infants include ….?

A

irriability, high pitched cry, and poor feeding, setting sun signs ( pupils are looking down), bulging fontanel, and separation of sutures

44
Q

ICP in infants late signs ….?

A

abnormal pupil signs , bradycardia , hypertension, decrease motor response and sensory , abnormal posture, and irregular breathing (Cheyne stokes)

45
Q

in late signs of ICP, what are the two postures called

A

decorticate and decerebrate

46
Q

what’s decorticate

A

arms are flex and internal rotated to core and legs are extended and rotated internally also

47
Q

what’s decerebrate

A

the arms and legs are extended and head is back

48
Q

Nursing intervention with ICP for infants

A

-keep bed at 30 degrees
-keep head at neutral mid line position
educate patient of strain activities such as coughing , sneezing/ blowing nose
administer stool softeners
insert urinary catheters
decrease stimulation such as a quiet environment, limit noise and visitors
limit suctioning
seizure precautions , suction and oxygen equipment avaible near bedside

49
Q

Medication prescribe for patient with ICP infant

A

mannitol (Reduction of intraocular or intracranial pressure)/ treat cerebral edema
antibiotic ( csf leakge and penertrating injury)
antiepileptic (treat seizures)

nursing (5 decks)

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